Abstract 17087: Doubled Survival From Out-of-Hospital Cardiac Arrest in a Rural Community in North-Norway Following Implementation of an Aggressive Chest Pain Protocol with Early Prehospital Thrombolysis for STEMI
Introduction Survival from prehospital cardiac arrest (PCA) remains low. Tromsø municipality in rural North-Norway has a mixed urban-rural population of 60.000, good ground and air ambulance systems, short response times, and dispatch centres staffed with nurses and paramedics, all loyal to current guidelines.
Hypothesis By changing focus from the onset of ‘collapse’ in PCA to the onset of chest pain in acute coronary syndrome, we hypothesized that more PCA-patients could survive by saving time to alarm, dispatch, diagnosis and first defibrillation. We started an aggressive criteria based prehospital chest pain protocol in 2000. Local GPs and ambulance paramedics were trained in symptoms and signs of STEMI, to access and transmit prehospital 12-leads ECG, give MONA as well as early prehospital thrombolysis (PHT) to patients with prehospital diagnosed acute STEMI. We applied defibrillation pads to all chest pain. The population was informed through media stunts.
Methods Retrospective study of survival from PCA during two 5-years periods in Tromsø (1999 -2004; 2004-2009). Each PCA patient's Utstein-chart, digital dispatch centre logs, hospital records and non-survivors autopsy reports were analysed.
Results Annual incidence of PCA with resuscitation attempts and ambulance dispatched was 45,3 pr. 100.000. During first 5-years, 10,5 % of all patients (18/172) with PCA were discharged alive. During second period, survival to discharge doubled to 22,3 % (31/139, p<0,05). Presence of an initial shockable rhythm (VF/VT) increased significantly. In patients with witnessed PCA of cardial etiology and a shockable first rhythm, survival to discharge was 21,4 % during the first 5-years period, but doubled to 44,2 % (19/43, p<0,05) in the second period. CPR was started by lay bystanders prior to ambulance arrival in 68,2 % of patients during first, increasing to 76,3 % during the second study period (NS). Prehospital ambulance response time was unchanged at 10 min in each period. By moving system attention ‘to the left of cardiac arrest’, survival to discharge doubled.
- © 2011 by American Heart Association, Inc.